To start off some balanced discussions of what universal health care looks like around the world, I thought I would begin with Australia, a system that we could learn a great deal from.
In the US system, we do not have universal healthcare, we have mostly employer-subsidized healthcare, private insurance and medicare covering people’s health expense. We also lack a universal electronic medical record, our main recourse for responding to poor care is lawsuits, and we have a high disparity in services available to those with money and those who do not. We still manage to spend more on health care per capita than any country in the world, while being ranked 37th in the world by the WHO, 72nd in the world for healthiness of its citizens, and 19th among industrialized countries (last) by the Commonwealth fund. We have a very poor infant mortality rate, which is only partially explained by our willingness to treat more premature infants than other countries, and is mostly a result of poor health care infrastructure in several of the poorer, Southern states.

Australia’s system is not too fundamentally different from the mixture of employer and public based funding found here in the US. An outline of the health system is available from the Australian government and the Wikipedia entry is here. It’s spends about 8.8% of GDP on health care, compared to the US at 15.3% based on 2007 OECD data (or 9% and 16% respectively according to the Commonwealth fund data). Of that, about two-thirds is public, one third private expenditure. Let’s take a closer look…

If you remember this figure we see a breakdown of how the Aussies are spending their money:
As well as our post on attitudes about health care around the world you see the Aussies spend a relatively larger amount of money out of pocket on health care, but almost half of what the US spends overall. Australia compares favorably with other nations in quality of care, and much better than the US. Australia also has one of the lowest mortality rates for health care amenable diseases among 19 industrialized nations. As described in the health affairs article we discussed, Australians report they can see a doctor within one day 40% of the time (compared to the US at 30%), have wait times for elective surgeries nearly identical to the US, and are less likely to avoid a physician or refill a prescription when sick because of worries about cost. Satisfaction with their system lags, with numbers comparable to that in the US. But considering that the system is actually doing a very good job based on the numbers, this might just be the very human tendency to never be satisfied with health care.

Australia’s system, called medicare, provides universal basic coverage to all citizens, and free treatment at public hospitals, and most treatments free or subsidized by the government. They cover dental, optho, and mental health, as well as services for the elderly and disabled. There is some cost-sharing, and that means at private hospitals government will pay a majority of the bill (75%), but at public hospitals they cover more or all of it. They subsidize prescription drugs that are listed on their scheme (not some more recreational drugs like Viagra) and have a safety net for those who can’t pay the ~$20USD co-pay on prescriptions. You can choose your doctor, or your hospital, public or private. Wait times are probably longer at the public hospitals for elective procedures.

All of this is funded by an additional income tax of 1.5% on all citizens, some out-of-pocket and cost sharing (about 20% of the total expenditures), private expenditures, and higher taxes on high-income individuals who do not purchase private insurance.

One of the reasons the system may be compatible with US preferences in health care is that above this baseline of universal health care, private insurance does exist to provide coverage over and above the basic government system. This would be more easy to implement in the context of a place like the US that has such a huge infrastructure devoted to private insurance provided by employers. People who make more money are expected to get private insurance (although it is subsidized by the government), and this coverage provides more ready access to private hospitals and more rapid access to elective procedures. 50% of the population opts for some private coverage above the basic health plan.

Criticisms of this system from within are that the mixture of private and public systems creates a two-tier system, but I think most in the US would be OK with this as we probably would prefer a system where we could pay more and get more, as opposed to a system like Canada’s in which you are forced to operate within the public system.

In summary, Australia provides universal coverage with a mixed public-private funding system. It provides some of the top care in the world as assessed by preventable mortality and healthiness of the population, but this may partly due to cultural characteristics of the population. Their total costs are dramatically less than that of the US system, costing almost half as much per capita, despite covering the entire population and retaining private elements.

I would like to hear from Australians about what they think of their system, with the caveat that individual descriptions of good or bad stories aren’t very informative since every system has its disasters and usually far more success stories that you never hear. I would like to hear if this description reflects the reality (I, of course, have never been treated in Australia), some more criticisms of the system, pitfalls we in the US can avoid and how it may be improved.

Comments

Medicare does not cover general dental, unless you are low income, and then it can be quite a long waiting time – this is probably the major gap in the system. Also, the Government sets a schedule of what it considers a reasonable fee for each medical service, and the rebate paid by medicare is based on that schedule. Doctors and other medical providers are able to charge more (and most do) with the gap being paid for by the patient. Private health insurance can cover the gap up to the schedule fee for services provided in hospital, or by arrangement with the service provider. For example, if I need a colonoscopy, I can get a referral to a specialist of my choice, but ideally I would go to one who already has an agreement with my health fund, so I have no out-of-pocket expenses. Health funds also cover things that medicare doesn’t cover, like general dental, physiotherapy, alternative medicine, and prescription optical (although the actual optometrist bulk-bills ie charges medicare directly). Public Hospitals basically cover emergency medicine, and publically funded elective procedures for which there is usually a long waiting list. Specialists usually do a limited number of elective procedures in the public system, with most of their work from privately paying patients. The public system also directly employs its own specialists.

That said, the public system does remarkably well, given it is always on limited resources. My wife had to have an appendectomy last year, and whilst she spend a night in the emergency ward, rather than being admitted straight away, the surgery was done the next day, and everything was covered. Since we have private cover (about $370AUD per month for very comprehensive cover), we elected to go into a private ward, but the option was there to stay public, and it would still have not cost us anything. Depending on the service, our local GP will bulk bill, or we may have to pay about $20 above what we get back from the medicare rebate.

Just a couple of other points. Private health insurance is currently kept somewhat cheaper by government subsidy, initiated by the conservative Howard government but largely continued under the current Labor government. The conservative reasoning is that it is good policy to encourage use of private health facilities via subsidy so as to lessen the demand on the government funded public system. The response from the “progressive” side is that is more effective to just put the money into making a better public system that everyone is happy to use.

It is common to hear Labor claim that the conservatives secretly want to abolish Medicare – the universal and uite popular system introduced under Federal Labor – whereas the conservatives will say Labor secretly wants to let the private health system die.

In practice, my guess is that the current middle ground will likely continue indefinitely. I’m not sure that any polling answers this question clearly, but my hunch is that private insurance is popular enough now that complete withdrawal of government subsidy would not be very popular. (It is viewed by many people as being only just affordable as it is.)

Surgery waiting lists in the public system, as well as the question as to whether the States are using Commonwealth supplied funds to run their hospitals effectively, are perennial topics of political discussion. The current PM, (Labor’s) Kevin Rudd threatened before his election that if the States did not improve public hospital performance in a short time with the extra funding he was providing, the Commonwealth could take over the hospital system. Few believed that this was genuine: why should the Feds bear all the political pain when you they can deflect it onto State government management? And indeed, in the last couple of days, the Federal Health Minister confirmed this was not an option “on the cards”.

The mix of public and health components is also viewed by most people as somewhat complicated, but the impression from media stories about the American system is that ours is much less “cut-throat” in practice, and most people expect and feel they receive pretty good health treatment, even if (as you say) there is always something for people to complain about.

The most obvious question from your post (to my mind) is: how on earth does the American system manage to spend so much more money for such ordinary outcome?

In some larger country centres “public” and “private” are the same dotors and same hospitals.

In the mid 80’s I had appendicitis and was misdiagnosed by my GP and finally transported to another regional hospital by ambulance. It was still only 12 hours from self admission to coming out of the theatre. Stayed in hospital for several days. No out of pocket costs that I recall. Apart from my (at the time, but not afterwards) GP, I was pretty impressed by my experience.

(ex)wife had two children (late 80’s), there was a nominal cost, I don’t recall exactly but of the order of 10s of dollars. Care was good.

Severe kidney stones early 90’s. Admitted immediately, no costs associated with treatment, including some sort of CT scan with radioactive (?) injection.

Various cuts, burns and a broken toe for myself and kids, all treated in emergency, no real complaints about any of the treatment.

I see my GP about 4 times a year now, gap is about 30$, insurance covers most of that. I take a blood pressure medication, about 30$/month cost to me. In the last couple of years I have needed scans associated with stomach pains (unresolved), 2 CT(?)scans no cost (wholy covered by medicare), 1 endoscope under anaesthetic about $100 (only because it was in a private hospital)

While I have had private medical insurance for many years I have rarely used it, other than above endoscope, and very recently for some dental work (replaced a cap which was 25+ years old) and twice since 2004 for glasses.
Last month did an aviation medical and opthalomist examination $170 in total and no medicare or insurance, but that is for “fun” (aviation professional would have been able to claim it).

I actually thought of self insuring (ie setting up my own fund) in the early 90s. If I had, notwithstanding a fairly extensive history of minor and moderate medical requirements I would be miles ahead financially.

I’m a bit inexperienced, and often pay little attention, but here are my thoughts:

As mrcreosote noted, the waiting lists for public dental are very long. Happily though, you can get “extras” only private insurance, which includes general dental, quite cheaply, and then it’s reasonable.

Many doctors don’t bulk bill, in which case you have to pay out-of-pocket and then claim (most of) it back. You can probably find one if you live in a big city. I generally go to the clinic at my university, which does.

According to the TV news we have a chronic shortage of doctors and nurses (and teachers), which probably contributes to waiting times. It’s particularly bad in rural areas. I guess we’re not alone in this, however.

Most of the private insurance funds cover at least homeopathy, accupuncture and naturopathy, so it’s a bit of a bummer to think that my fees are (slightly) increased to pay for a bit of quackery, but I doubt they increase costs significantly.

I thank you all for such helpful, informative comments. Not experiencing the system first hand I can not of course flush out all the details you guys are able to provide so it’s very appreciated. This is, of course, the ideal use of blogging to have people inform such conversations from around the world.

For those that are confused “cost-sharing” refers to the implementation of things like co-pays or some fees for hospital services. They tend to be nominal and exist to create a financial incentive not to abuse the system, and to partially subsidize care.

Thanks so much!

In terms of why the US costs so much more, we’re going to talk about why that occurs after we’ve talked about some more systems. I think by Friday I should have finished covering most the major healthcare systems I’m interested in, tomorrow will be the Netherlands, then Germany, then France, and then I have yet to write a combined post on the single-payer systems in UK, Canada and New Zealand. The cost issue is incredibly important, but I think by Friday the answer will be illuminated.

“but this may partly due to cultural characteristics of the population”

Well as Australians are currently ranking as the worst (or best, depending on how you look at it) in the world when it comes to obesity, and that most of our cultural characteristics revolve around drinking obscene amounts of alcohol, I’d say the success of our health system is even more amazing given our cultural characteristics.

I broke my leg atempting to ride a motor scooter while … in a condition where I shouldn’t have atempted it. I now have a titanium pin in the leg. The hospital stay, the operation, the drugs, the pin istelf – all covered. The very notion that someome in immediate need like that should have to worry about money – I find it shocking. But it’s business as usual in your country.

I don’t have private cover. I earn enough that I am subject to an additional medicare levy which the Howard government put in place to keep the private insurers alive. If it weren’t for that extra medicare levy for well-off folks without private cover, the private insurers would have gone out of business years ago.

But I don’t mind paying it. I like to think that the money goes more-or-less directly to people in need of it.

You know: it’d be simple in the US to set up the aussie system, within your existing framework. You allready have dozens of health insurerers and the accounting infrastructure to manage them. Why not one more?

1 – set up a government-owned nonprofit corporation. Call it medicare. It’s board of directors are public servants reporting to the surgeon general.

2 – supply this corporation with an enormous bucket of money.

3 – register this corporation as a health insurer, which pays out money for procedures like a regular insurer. Paperwork, website, etc.

4 – Grab a list of procedures covered and a payment schedule from an existing iunsurer. Keep the childhood vaccination, strike put the boob jobs.

5 – Accept claims from any American with an SSN, and pay them out according to the schedule.

And there you go. And now the magic bit:

6 – since this entity is a registered health insurance provider, employers may sign up for -oooh, say a dollar a year – and so stay within the letter of the law about having to provide health insurance.

I get community mental health (nurses & psychs & counsellors & activities & help getting a job or training) completely free, don’t even have to sign a medicare form to bulk bill. I think this is part of the hospital system, which is run by each State.

With “Public” systems in federal countries, you need to pay attention to which government pays what. In Australia, all the infrastructure (doctor salaries, hospitals, etc.) is paid by the states in what amounts to the mother of all unfunded mandates. Many of the problems associated with the system are a result of buck-passing between the federal and state governments.

MrCreosote provides most of the info that you might not ahve touched. Australia’s system fails to adequately cover dental – and there are other items like optical and CAM that public insurance doesn’t cover that private offers.

The state subsidisation of priavte insurance does have a basis, in that in theory the more people who can afford private insurance the less strain on the public system. But it means less money for the public system (which can always use more money).

I love our PBS (the co-pay system that reduces prescription medicine costs for vital medicines), and back when I was a student the low-income health care card was a literal lifesaver when it came to affording medicines. Bulk-billing is great too – but I’ve actually noticed it’s less common in the big city. All the GPs back home did it – here in Sydney it looks like I have to go to a specific family or stop’n’go style clinic to get it.

Being able to go to a doctor and not be anxious about the bill for both the visit, and whatever you get prescribed is what a modern public health system should provide.

Australia being a large country (similar to the US), but with a disproportionate allocation of population is an issue when it comes to infrastructure. Regional and rural areas can be in a bit of a bind, with many complex procedures needing to be referred to the nearest capital city (which can be over a day’s drive away). This is probably where our health system could improve the most – and that is mostly down to individual states (who obviously place the best hospitals where the most voters are).

When we talk about ‘next-generation’ medicine, we tend to think about advances in treatments, diagnostic tools or preventative approaches such as vaccines. But what about ‘next-generation’ healthcare providers?

Just to confirm that Australia’s public health system does not cover dental for most citizens, only for the low income bracket. However, the government is looking at funding at least basic dental through the Medicare system.

Another point, one that the private system advocates do not like to mention, is that in Australia if you have a serious health problem in Australia, you will almost always get treated in the public system at a teaching hospital. In other words, generally speaking the private system cherry picks the profitable patients and cases, and dumps the hard, expensive ones on the public system. And the private system still needs a 30% tax rebate on premiums to survive! Genuinely competitive it sure ain’t.

Unlike others, I am not so sure that the removal of the 30% rebate would be so politically problematic, as it is not that popular. Many people only take out private insurance, (and only the minimal amount), because of the punitive sanctions if they do not, and/or to cover ‘extras’ like dental, ‘elective’ surgery, etc. Many privately insured people still use the public system as their first port of call for serious expensive stuff.

Lastly, the use of the terms private and public can be confusing to those who do not know our system. Even if you see a private doctor, in most cases you can still get the bulk of the cost covered by the public insurance scheme, as a rebate. You pay the bill, then go and claim the bulk back from Medicare.

It is not just “funded by an additional income tax of 1.5% on all citizens” – a large chunk of general tax revenue is also used.

Public hospital waiting times for non-urgent things (joint reconstructions or replacements) can be long – weeks or even months. Public hospital waiting times for kidney stones, breast cancer, or other conditions that get worse with time are impressively short – faster than if you choose a specialist and pay via private insurance.

Some Australian states also have no-fault traffic injury treatment and income protection, which pays for comprehensive care and rehabilitation.

The Australian satisfaction ratings will have been reduced by a decade of having a government ideologically committed to
a) private health insurance and provision and
b) criticising the Australian state governments who are the actual providers of hospital based public health care (and were all led by the opposite political party) in an attempt to gain votes

I have read with great interest, including the comments, the articles about health care. I agree, very much, about the issue of health care in the U.S and that something must be done and this blog has presented some good ideas.
The problem I have with government funded system, of any kind, is the problem if “mission creep” (in the military this means the tendency of missions to get larger and larger and larger than originally intended).
For example, social security is no where near the original intent of when it was written. It has exploded into a burden due to the amounts in/out.
Again, Medicare is another example.
The problem is that the government (meaning Congress) can’t leave well enough alone.
Another problem is adequate funding. There are many examples to show.
The interstate highways were adequately funded for construction, but as the years passed, funding was siphoned off for other items and today we have a rusting infrastructure.
Again, social security was meant to be a buttress for retirement (not the retirement) and is now (or will) running out of money.
The argument is not for/against the services, but the cautionary tale is the federal government’s short attention span, the unwillingness to fund adequately and for the long term and to resist adding things unrelated to the original item (and when things are added, funding usually does not follow).
It has been noted that insurance companies deny and ration care–what will prevent the national insurance company of the same mentality-as congress cuts funding or worse, plays politics with the funding-what will keep the bureaucrat from denying the doctor the MRI that is needed-but for the cost/benefit analysis?
I agree a tier system would be best. Private care for all, and a backup for those who cannot afford.
100% detectability of all medical expenses, regardless of income (not this 20% cap crap of today).
A good national plan with strict limitations of the powers to be to change the plan, deny, etc. to hinder the government’s tendency to screw it up.
Please understand, I am not against universal health care of some kind-that we just need to be very aware that our current political system will probably screw it up.

I’d love to see a system like Australia’s, and I agree that the mixture of public and private is more in keeping with the ideals of most Americans. In fact — and this may be an unpopular thing to say on this blog, but I’ll say it anyway — IMO the freedom to seek out your own private healthcare is somewhat of human rights issue. I have ideological problems with Canada’s system that are independent of the debate over level of care.

Fans of Canada’s system often tell me that having the option of private insurance undermines the public system, but I think Australia is proof that is not the case.

Unfortunately, mental health treatments have only recently been added to the list of subsidised treatments. And many psychologists haven’t adapted to the idea of having their practice covered by medicare.

This means that getting a psychological treatment is cheaper, but not free as it should be. There are organisations and charities that help out with this, though.

As for the rest of it, I haven’t had too much trouble health-wise. Wait times are my biggest complaint, and that’s on the order of minutes in a GP’s office. I have spent four hours waiting for care in an emergency room, but I assume that’s because the triage nurse figured the case was very minor.

If only she’d told me at the time, a lot of time could have been saved

One thing that hasn’t been mentioned is that Australia’s demographics are very different from those in the US.

85% of all Australians live in one of about a dozen cities (including suburbs). 65% live in the top five. (Australians, as you might imagine, don’t really have the concept of a “home town”.)

This concentration of population impacts the economics of providing health care. Naturally, most medical graduates want to live where everything is. So if you are in the 85%, you are usually very close to whatever you need, including weird specialist services and GPs that bulk bill.

However, if you are in the small number who live in the outback, then you are an absurdly long way from anything, including any GP at all. We have ways around that, but it’s worth noting that health services to regional areas, especially indigenous communities, is a real, serious problem in Australia.

AS previous posters have made clear, the Australian system is far from perfect.

Btu based on my experience of the Australian system and reports of the US system, I have to say the Australian system seems preferable.

I’m diabetic my glycometer supplies are subsidised, if I progress to the point of needing medication or insulin, that’ll be subsidised too.

Under the US system, those supplies and medications aren’t subsidised for most people. But if an American’s diabetes progresses the point where they suffer blindness or end up having a hand or foot amputated then the chances are they’ll end up dependent on Medicare or Medicaid.

Ian brings up what I think is the most important point: The US system is reactive and the Australian system is proactive. This is, I suspect, responsible for a large proportion of the difference in cost.

No, the Australian system isn’t perfect. Most of the complaints against the system are about small details (e.g. that disease X isn’t covered where disease Y is). However, it’s telling that every time someone wants to badmouth a proposed health care reform, they just claim that it will create a “US-style system”. This, in Australia, is considered FUD.

It’s worth mentioning a couple of other points – our Pharmaceutical Benefits Scheme is effectively a single payer system for most commonly prescribed drugs. You’ve noted that, but it’s worth expanding what it means for us.

It means that most people are paying no more than $30 (Australian) per month for their drugs, with people on welfare benefits (including the aged pension) paying a few dollars per prescription.

That alone is a huge difference, particularly for the personal cost of treating long term conditions.

And the fact there’s no real relation between insurers and drug subsidy (for PBS covered drugs, at any rate) means that you don’t lose access to drugs (through affordability issues) if you lose your job.

And it’s also worth noting that our broader mortality figures (particularly child mortality) will be skewed upwards by the utterly appalling state of the health system in indigenous communities, which lags far, far behind any standards that would be considered acceptable anywhere else.

One thing that doesn’t appear to have been mentioned is that (for hospitalisation) you pay nothing if you go public (although you may have to wait), but if you use your private insurance you will probably have to pay extra. That is, private insurance does not cover all your costs.

When my father had a stroke, my mother admitted him to hospital on his private insurance. After he died, while she still had her pension suspended pending probate (ie, no income), she had debt collectors knocking on her door.
I didn’t know about this until much later; my view is that the hospital debt was my father’s and the debt collectors should have been hassling the executor not my mother.
But if he had been treated in the public system there would have been no debt.
And clearly the private system did not improve the outcome.

The only reason I have private insurance is the tax incentives — and I’m now going to recalculate under the new budget (including a component for my dislike of the private system given my mother’s experience).

The system in Australia is an odd mix but generally works well for the most part. For example, a patient entering a private ward in a public hopsital for elective surgery will pay for the surgical procedure, the surgeon and any ‘hardware’, but if they use the anaesthetist on duty they don’t pay for that service, the public health system does. Naturally if you have private insurance your out-of-pocket expenses can be quite low. A common elective surgery – gastric banding, costs around $15,000 AUD, of which you might expect to pay an excess of between $200-$1000 depending on your level of cover.

It is a bit quirky and the general view of the health care system is that it has slipped somewhat in recent years as we have moved closer to the US model. However, by and large it works to deliver positive health outcomes.

I think overall our system works very well. I think compared to the US systems which seems to be largely employer based, here in Australia no private health fund can reject you applying for their cover so long as you can make the monthly payment. We have the option of choosing any health fund that we desire and there is the option to go with a non-for-profit provider. One thing I will say is that despite having the top level private insurance, ocassionally I’m still hit with a hefty bill. Recently I sought medical care from a bulk billed general practice who ran a ton of blood tests all for free but I didn’t get better so I finally ended up at a specialist. That visit cost me $240, which is not covered by my private insurance, and I only got $70 back from medicare. Here if you want top level care you still have to pay for it.

As an older Australian citizen with a disability I rely on govt. benefits. my medical treatment has all been free plus subsidised dental treatment with an initial waiting period, but I now can get an appointment within a couple of weeks. (I believe the Labor govt. is about to substantially increase funding to dental.) I am an outpatient at a teaching hospital and see a specialist or registrar twice a year, I can get all blood tests, xrays, occupational therapy, neurology tests, minor surgery,all for free, plus subsidised pharmacy $5.30 for a $30 prescription. As a single, older person, I also have a good social security safety net with a substantial benefits increase in a couple of weeks. Also I can visit a GP for free who bulk bills. I also a spent an all for free week in hospital and managed to score a modern en suite room equipped with emergency goodies.(but that’s another story.)I have some waiting time up to 6 months eg for the neurology test, but it wasn’t an emergency. If I have an emergency I can be triaged at my local hospital and be treated for free. So far, so good. if I could afford it I would take private insurance, but fortunately the system looks after me without it. I worry for my American friends, who’s culture seems to be wrapped up in fiduciary concerns and sees universal healthcare as some kind of socialist bogey not a humanitarian right. It’s going to require a major cultural shift of the mindset I’m afraid. That is the message of Obama, change your mind, you really don’t have any other choice.

I have good medical coverage with medicare and military health insurance to cover the gap. My partner is Australian but living with me in WA state. His experience that I saw using the Australian system included waiting for appointment to any specialist. In order to obtain surgery to help his PD symptoms there was a years wait; standard here if one has a pre existing condition. So far over a year later Medicare Australia plus GMF private have not paid the neurologist bill that is owed. I have read the policy which says it should be paid– waiting on Medicare to pay first or is it the other way around? It seems to me that there is no perfect system which can include all in comprehensive health care. We do not have it unless one has work related coverage, or as in my case, military assistance when one is retired. Maybe it is about amount of people who live within a country which includes a lot of illegals who put pressure upon the existing health system we have.

Here’s a real life scenario. I have Parkinson’s disease. My ex wife set me up with a gambling based issue via the IGA (independent gambling authority) which prevented me from getting the neurologists permission for DBS procedure in South Australia.
I went to Victoria where the neurologist still wante assurance I wasn’t gambling before he would consider the operation.
I joined a private fund waited a year to get what was freely available on the basis of a life threatening operation. Something I have taken issue to the minister for health over.
It’s been 1.5 years since the (very successful) operation now and my surgeon still hasn’t been fully paid by Medicare or the private fund and my neurologist is billing through h back door via he surgeon.
So much for SOCIALIST medicine
I am now living in the USA where it costs me half my private health fund costs. So stick that where it deserves to go Australia.

i just got back from sydney today, while there i talked to my friends there about medical care- there is cost out of pocket there and the government healthcare is paid for by a 10 % value added tax on ALL goods and services , also gas is 1.20 ad a liter anput 4.80 a US GALLON. ABOUT 50% OF THEIR PETROL PRICE IS TAXES- THERE IS ALSO A TAX ON MANUFACTURED GOODS THE MONEY DISTRIBUTED AMONG THE STATES IN AUSTRALIA HE STATED, WHEN HE BROKE HIS LEG LAST YEAR HE WAITED 8 DAYS FOR THE OPERATION–( A BROKEN LEG)

IT IS A GOOD SYSTEM BUT IT IS ALL PAID FOR BY TAXES THAT AMERICANS WONT PAY– IMAGINE 6 DOLLARS A GALLON FOR GAS HERE???/?, AND REMEMBER AUSTRALIA HAS THE POPULATION OF CALIFORNIA AS DO MOST COUNTRIES WITH UNIVERSAL HEALTHARE NOT OVER 300 MILLION PEOPLE LIKE THE USA HAS .MY FRIEND ALSO HAS AN OPTION TO BUY ADDITINAL HAEALTHCAE TO COVER HIMSELF AND IT IS CHEAP MAYBE $1200AD A YEAR FOR A SINGLE PERSON BUT BUT BUT THEY ALSO DONT HAVE 10 MILLION LAWYERS LIKE WE HAVE THET AE KILLING THE SYSTEM– THEY HAVE A TYPE OF TORT REFORM THAT OBAMA WONT ACT ON

Why not have a system where the patient is billed and collected from directly? Then, the individual has to petition Medicare, Medicaid or private insurance for reimbursement. This would force people to make real decisions about their health care based on whether or not they truly need or desire care. It avoids the “treat me at any cost” mentality and puts the decision process squarely in the hands of patient and doctor– where it should be.

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